The aim of the work proposed here is to demonstrate the feasibility Encouraging Handwashing Messages (EHM). The intent of EHM is to increase hand hygiene on a hospital floor by rewarding good hand hygiene with a voice message praising the listener. In Phase I, EHM will play voice messages at the Weinberg Intensive Care Unit at Johns Hopkins Hospital in Baltimore, MD. EHM's anticipated effect is an increase in hand hygiene there. There will be two phases in the proposed research: Pre-test, and Test. The dependent variable in each phase will be the hand hygiene rate and the independent variable will be the presence of voice messages. The Pre-test Phase will establish baseline compliance and the Test Phase will measure compliance in the presence of voice messages. We will claim that EHM is feasible if the hand hygiene compliance rate increases significantly, at the 5% level, from Pre-test to Test Phase. In Phase II we will install EHM on several units at Johns Hopkins Hospital and determine the change in both the hand hygiene rate and the hospital acquired infection rate. Steris Corporation, a company with a half-billion dollars in sales in the hand hygiene field, has signed an agreement with Amron Corporation under which Steris will buy 10 Hand Hygiene Prompts for testing and evaluation. Steris has agreed to donate the hardware to be used in the work proposed here as part of that agreement, making about $9,400 available for other purposes. In Phase III, Encouraging Hygiene Measurements will be included in Steris Corporation's Program of Solutions third tier, where it will provide automated voice messages and electronic hand hygiene compliance measurement on hospital floors. PUBLIC HEALTH RELEVANCE: Encouraging Hygiene Messages (EHM) will encourage hand washing and hand sterilization in hospitals. It will affect public health by reducing the chance of a patient acquiring an infection in a hospital - a public place. EHM has the potential to reduce the cost of hospital acquired infections by a billion dollars and a hundred thousand deaths per year in the United States. [unreadable] [unreadable] [unreadable] [unreadable]